脑出血急性期血压与预后的相关性研究  

Study on correlation between blood pressure and prognosis in patients with acute cerebral hemorrhage

作　　者：丁倩倩[1] 邵国富[1] 魏义兰[2] 刘瑞杰 沈明强[4] 

机构地区：[1]苏州大学附属第二医院神经内科,江苏苏州215004 [2]北京市顺义区医院神经内科,北京101300 [3]广饶县人民医院神经内科,山东广饶257300 [4]苏州市立医院神经内科,江苏苏州215000

出　　处：《现代医药卫生》2013年第7期977-980,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨脑出血急性期血压与预后的关系,以指导临床脑出血患者急性期的血压管理。方法采用前瞻性队列研究方法,监测发病24 h内入院的脑出血患者入院后7 d内的血压,记录其入院时神经功能缺损情况,并对其既往史、伴发疾病情况、病情变化进行评估,随访其发病6个月时的死亡/残疾情况,并采用SPSS17.0统计软件对数据进行分析。结果共纳入并完成随访的患者366例。脑出血入院时收缩压、第1天平均收缩压与发病6个月时死亡/残疾率呈J型关系,随着血压的升高死亡/残疾率增加。入院后7 d平均血压在120～160/70～80 mmHg(1 mmHg=0.133 kPa)时预后较好。发病24 h内血压下降越显著,发病6个月时死亡率越高。收缩压及舒张压的7 d连续性变异率与6个月预后呈U型关系,变异率均在5～15 mmHg时死亡率和死亡/残疾率最低(P<0.05)。影响预后的主要血压因素为24 h收缩压下降率及血压连续性变异率。结论脑出血急性期血压独立影响预后,临床工作中可适当积极降压治疗,但应注意血压的平稳性。Objective To explore the relationship between blood pressure （BP） and prognosis in the patients with acute cerebral hemorrhage to guide the BP management in acute phase. Methods By using the prospective cohort study, BP within 7 d in the patients admitted within 24 h after the onset of cerebral hemorrhage was monitored, the neurologie impairment status was recorded, the past history, concomitant disease and disease condition changes were evaluated, and the death/disability in 6 months after onset were followed up. The obtained data were analyzed by the SPSS17.0 statistical software. Results 366 cases were in- clued in this study and accomplished follow up. The J-shaped relationship was found between the SBP on admission and average SBP on 1 d with 6-month death/disability rate. The mortality and disability rates were raised with SBP increase. The average BP 120-160/70-80 mmHg on 7 d had a better prognosis. The more significantly SBP and DBP decreased within 24 h ,the higher the mortality rate in 6 months. The U-shaped relationship was found between the 7 d successive variation rate of BP and the 6-month prognosis. The variation rate of 5-15 mmHg had the lowest mortality and disability rates （P〈0.05）. The main BP factors influenc- ing prognosis were 24 h SBP decrease rate and the variation rate of BP continuity. Conclusion BP in the acute phase of cerebral hemorrhage is an independent prognostic factor. Suitable active antihypertensive therapy could be performed in clinic, but the BP stability should be paid attention to.

关 键 词：脑出血 血压 高血压 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]